基于“三辨模式”运用苍附导痰汤加味治疗多囊卵巢综合征的临床研究

Clinical effect of modified Cangfu Daotan decoction in treatment of polycystic ovary syndrome based on constitutional differentiation,disease differentiation,and syndrome differentiation

目的:研究基于“三辨模式”运用苍附导痰汤加味治疗脾虚痰湿型多囊卵巢综合征(PCOS)合并胰岛素抵抗的临床效果。方法:选取120例脾虚痰湿型PCOS合并胰岛素抵抗患者,按照随机数字表法分为治疗组和对照组,每组各60例。对照组采用口服二甲双胍治疗,治疗组在对照组基础上采用苍附导痰汤加味治疗,疗程均为3个月。比较2组治疗前后的胰岛素抵抗相关指标[空腹胰岛素水平、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、中医证候积分、子宫内膜容受性相关指标(卵巢体积、子宫内膜厚度)水平、性激素指标水平,并评价综合疗效。结果:总有效率治疗组为96.67%(58/60),高于对照组的80.00%(48/60),差异有统计学意义(P<0.01)。与治疗前比较,治疗后2组空腹胰岛素水平、HOMA-IR、中医证候积分、性激素指标水平均下降,卵巢体积缩小,HOMA-β、子宫内膜厚度值均升高,且治疗组改善幅度均大于对照组,差异均有统计学意义(P<0.05或P<0.01)。结论:苍附导痰汤加味治疗脾虚痰湿型PCOS合并胰岛素抵抗患者效果显著,可明显改善患者胰岛素抵抗相关指标、子宫内膜容受性相关指标,降低中医证候积分及性激素水平。

Objective:To investigate the clinical effect of modified Cangfu Daotan decoction in the treatment of polycystic ovary syndrome(PCOS)with insulin resistance based on constitutional differentiation,disease differentiation,and syndrome differentiation.Methods:A total of 120 PCOS patients with insulin resistance and the syndrome of spleen deficiency and phlegm-dampness were divided into treatment group and control group using a random number table,with 60 patients in each group.The patients in the control group were given oral administration of metformin,while those in the treatment group were given modified Cangfu Daotan decoction in addition to the treatment in the control group,and the course of treatment was 3 months for both groups.The two groups were compared in terms of insulin resistance-related indices(fasting insulin,homeostasis model assessmentβ-cell function[HOMA-β],and Homeostasis Model Assessment of Insulin Resistance[HOMA-IR]),TCM syndrome score,endometrial receptivity indices(ovarian volume and endometrial thickness),and sex hormone indices before and after treatment,and overall response was evaluated.Results:The treatment group had a significantly higher overall response rate than the control group[96.67%(58/60)vs 80.00%(48/60),P<0.01].After treatment,both groups had significant reductions in fasting insulin,HOMA-IR,TCM syndrome score,and sex hormone indices,a significant reduction in ovarian volume,and significant increases in HOMA-βand endometrial thickness,and the treatment group had significantly greater improvements than the control group(P<0.05 or P<0.01).Conclusion:Modified Cangfu Daotan decoction has a marked clinical effect in the treatment of PCOS with insulin resistance and the syndrome of spleen deficiency and phlegm-dampness and can significantly improve insulin resistance-related indices and endometrial receptivity indices and reduce TCM syndrome score and sex hormone indices.